Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Indian J Pediatr. 2011 Feb;78(2):227-33. doi: 10.1007/s12098-010-0296-6. Epub 2010 Dec 11.
Upper gastrointestinal bleeding is a life threatening condition in children. Common sources of upper gastrointestinal bleeding in children include variceal hemorrhage (most commonly extra-hepatic portal venous obstruction in our settings) and mucosal lesions (gastric erosions and ulcers secondary to drug intake). While most gastrointestinal bleeding may not be life threatening, it is necessary to determine the source, degree and possible cause of the bleeding. A complete and thorough history and physical examination is therefore vital. Esophagogastroduodenoscopy and colonoscopy are currently considered the first-line diagnostic procedures of choice for upper and lower GI bleeding, respectively. The goals of therapy in a child with GI bleeding should involve hemodynamic resuscitation, cessation of bleeding from source and prevention of future episodes of GI bleeding. Antacids supplemented by H2- receptor antagonists and proton pump inhibitors are the mainstay in the treatment of bleeding from mucosal lesion. For variceal bleeds, therapeutic emergency endoscopy is the treatment of choice after initial hemodynamic stabilization of the patient. Independent prognostic factors are presence of shock and co-morbidities. Underlying diagnosis, coagulation disorder, failure to identify the bleeding site, anemia and excessive blood loss are other factors associated with poor prognosis.
上消化道出血是儿童生命威胁的情况。儿童上消化道出血的常见来源包括静脉曲张出血（在我们的环境中最常见的是肝外门静脉阻塞）和黏膜病变（药物摄入引起的胃侵蚀和溃疡）。虽然大多数胃肠道出血可能不会危及生命，但有必要确定出血的来源、程度和可能的原因。因此，完整和彻底的病史和体格检查是至关重要的。食管胃十二指肠镜和结肠镜检查目前被认为是上消化道和下消化道出血的一线诊断程序。儿童胃肠道出血治疗的目标应包括血流动力学复苏、停止源头出血和预防未来胃肠道出血发作。抗酸剂联合 H2 受体拮抗剂和质子泵抑制剂是治疗黏膜病变出血的主要方法。对于静脉曲张出血，在患者初始血流动力学稳定后，治疗性紧急内镜检查是首选治疗方法。独立的预后因素是休克和合并症的存在。潜在诊断、凝血障碍、未能确定出血部位、贫血和大量失血是与预后不良相关的其他因素。
